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The natural history of bone marrow lesions in community-based adults with no clinical knee osteoarthritis
  1. M L Davies-Tuck1,
  2. A E Wluka1,2,
  3. Y Wang1,
  4. D R English2,3,
  5. G G Giles3,4,
  6. F Cicuttini1
  1. 1
    Department of Epidemiology and Preventive Medicine, Monash University, Central and Eastern Clinical School, Alfred Hospital, Melbourne, Australia
  2. 2
    Baker Heart Research Institute, Melbourne, Australia
  3. 3
    Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, The University of Melbourne, Carlton, Australia
  4. 4
    Cancer Epidemiology Centre, The Cancer Council of Victoria, Carlton, Australia
  1. Professor F Cicuttini, Department of Epidemiology and Preventive Medicine, Monash University, Central and Eastern Clinical School, Alfred Hospital, Melbourne, Victoria 3004, Australia; flavia.cicuttini{at}


Objective: Although bone marrow lesions (BML) have been implicated in the pathogenesis of osteoarthritis, their natural history in a healthy population is unknown. This study in a healthy, pain-free population aimed to examine the natural history of BML; factors associated with incidence and progression of BML over 2 years and whether incident BML are associated with the development of pain.

Methods: 271 subjects with no clinical knee osteoarthritis, being pain free at baseline, underwent magnetic resonance imaging of their dominant knee at baseline and 2 years later. The presence of BML was assessed.

Results: In knees initially free of BML, incident BML developed in 14% of people over the study period. Increased body mass index (BMI; odds ratio (OR) 1.15, 95% CI 1.06 to 1.2, p = 0.001) was associated with incident BML. Those who developed a BML were more likely to develop knee pain compared with those in whom no BML developed (OR 4.2, 95% CI 1.2 to 15.1, p = 0.03). Among those in whom BML were present at baseline, 46% completely resolved. There was no association between age, gender and BMI and persistence of BML over 2 years.

Conclusion: In this healthy population, the rate of incident BML is lower than previously described in a population with osteoarthritis. Incident BML are associated with increased BMI and the development of pain. Approximately half the BML present at baseline resolved. These data suggest that in pain-free people with no clinical knee osteoarthritis, BML are reversible and may provide a target for interventions aimed at the prevention of knee osteoarthritis.

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  • Competing interests: None.

  • Funding: The Melbourne Collaborative Cohort Study recruitment was funded by VicHealth and the Cancer Council of Victoria. This study was funded by a programme grant from the National Health and Medical Research Council (NHMRC; 209057) and was further supported by infrastructure provided by the Cancer Council of Victoria. AEW and YW are the recipients of NHMRC public health fellowships (317840 and 465142, respectively). MLD-T is the recipient of an Australian postgraduate award PhD scholarship.

  • Ethics approval: The study was approved by the Human Research Ethics Committee of the Cancer Council of Victoria and Monash University Standing Committee on Ethics in Research Involving Humans.

  • Patient consent: Obtained.

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